Hepatitis C Screening and Management Practices: A Survey of Drug Treatment and Syringe Exchange Programs in New York City

Injection drug users (IDUs) account for more than 60 percent of all new hepatitis C virus (HCV) infections in the United States. Fifty to eighty percent of new IDUs are infected within 6 to 12 months of initial injection. Current treatment regimens are not highly effective, and no vaccine against HCV is available.

Studies suggest that drug treatment and syringe exchange programs play a role in reducing HCV infection among participants by promoting drug abstinence or safer injection practices among those who continue to use drugs. The New York City Department of Health conducted a survey of local drug treatment and syringe exchange programs to determine whether their HCV screening and counseling practices were carried out, as recommended in recent federal guidelines.

In March 1999, 141 agency directors (all 132 drug treatment programs listed in the state drug services directory, nine syringe exchange programs and eight unaffiliated drug treatment programs) received a survey asking about client characteristics, hepatitis screening (based on laboratory testing or client self-report), HCV education and counseling and barriers to offering HCV services. Seventy percent of the programs (99) and four syringe exchange programs responded. The analysis of data was based on 113 questionnaires completed by 109 programs and the four syringe exchange programs.

Findings from the study included the following:

• Of the 113 programs, 72 percent employed social workers and 70 percent and 61 percent employed at least one physician and one nurse, respectively. Sources of funding included state government (60 percent), private (41 percent), federal government (32 percent) and local government (28 percent).

• Twenty-seven programs enrolled clients younger than 18 years; 78 percent reported current drug use among clients, including intranasal cocaine use (73 percent), intranasal heroin use (62 percent), and injection drug use (49 percent).

• Fifty-five (50 percent) of drug treatment programs and none of the syringe exchange programs screened for HCV infection, citing reasons that included not within the scope of services, no health care providers, and lack of funding.

• Of the 55 drug treatment programs that screened for HCV, 82 percent screened on admission to the program. Ninety-six (85 percent) of all programs provided hepatitis C-related referral services.

• Ninety (80 percent) programs (86 drug treatment programs and four syringe exchange programs) provided hepatitis C education and counseling. Nearly all programs advised their clients not to share needles and to use condoms when having sex. Most consistently recommended not sharing toothbrushes or razors, abstaining from or minimizing alcohol consumption, not frontloading or backloading (shared syringe use), and screening for HCV infection partners of clients who were HCV positive.

• Program directors expressed the most concern about the lack of education and training materials for providers. Other concerns included funding and medical coverage, need for a screening facility and difficulty arranging treatment with outside HCV providers.

This survey, among others, found that despite enrollment in treatment programs, many clients continue to use illicit drugs and engage in practices that place them at risk for HCV infection. Because drug treatment programs and syringe exchange programs provide access to the highest-risk population for HCV, targeted screening at these facilities would prove to be cost-effective, especially among younger clients who may have the highest incidence of HCV. Facilities should be provided with adequate resources to initiate and expand their HCV screening and education programs, the authors concluded.

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